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0 0.5 1 1.5 2+ Ventilation 65% Improvement Relative Risk Antibody formation 67% Probiotics for COVID-19  Zhang et al.  LATE TREATMENT Is late treatment with probiotics beneficial for COVID-19? Retrospective 55 patients in China No significant difference in outcomes Zhang et al., J. Gastroenterology and .., Mar 2022 Favors probiotics Favors control

Gut microbiota-derived synbiotic formula (SIM01) as a novel adjuvant therapy for COVID-19: An open-label pilot study

Zhang et al., Journal of Gastroenterology and Hepatology, doi:10.1111/jgh.15796, NCT04581018
Mar 2022  
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Probiotics for COVID-19
17th treatment shown to reduce risk in March 2021
*, now known with p = 0.0000013 from 26 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Pilot study of probiotic SIM01 with 25 consecutive COVID-19 patients in Hong Kong and 30 control patients treated by a different team during the same time period, showing improved antibody formation, reduced viral load and pro-inflammatory responses, and improvements for gut dysbiosis. SIM01 contains bifidobacteria strains, galactooligosaccharides, xylooligosaccharide, and resistant dextrin (derived from metagenomic databases of COVID-19 patients and healthy patients).
The immune effects of probiotics are strain-specific.
risk of mechanical ventilation, 64.7% lower, RR 0.35, p = 1.00, treatment 0 of 25 (0.0%), control 1 of 30 (3.3%), NNT 30, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of no antibody formation, 67.3% lower, RR 0.33, p = 0.06, treatment 3 of 25 (12.0%), control 11 of 30 (36.7%), NNT 4.1.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zhang et al., 2 Mar 2022, retrospective, China, peer-reviewed, 12 authors, trial NCT04581018 (history). Contact:,
This PaperProbioticsAll
Gut microbiota‐derived synbiotic formula (SIM01) as a novel adjuvant therapy for COVID‐19: An open‐label pilot study
Lin Zhang, Zhilu Xu, Joyce W Y Mak, Kai Ming Chow, Grace Lui, Timothy C M Li, Chun Kwok Wong, Paul K S Chan, Jessica Y L Ching, Yasuhiro Fujiwara, Francis K L Chan, Prof. Francis Siew C Ng
Journal of Gastroenterology and Hepatology, doi:10.1111/jgh.15796
Background and Aim: Gut dysbiosis is associated with immune dysfunction and severity of COVID-19. Whether targeting dysbiosis will improve outcomes of COVID-19 is unknown. This study aimed to assess the effects of a novel gut microbiota-derived synbiotic formula (SIM01) as an adjuvant therapy on immunological responses and changes in gut microbiota of hospitalized COVID-19 patients. Methods: This was an open-label, proof-of-concept study. Consecutive COVID-19 patients admitted to an infectious disease referral center in Hong Kong were given a novel formula of Bifidobacteria strains, galactooligosaccharides, xylooligosaccharide, and resistant dextrin (SIM01). The latter was derived from metagenomic databases of COVID-19 patients and healthy population. COVID-19 patients who were admitted under another independent infectious disease team during the same period without receiving SIM01 acted as controls. All patients received standard treatments for COVID-19 according to the hospital protocol. We assessed antibody response, plasma proinflammatory markers, nasopharyngeal SARS-CoV-2 viral load, and fecal microbiota profile from admission up to week 5. Results: Twenty-five consecutive COVID-19 patients received SIM01 for 28 days; 30 patients who did not receive the formula acted as controls. Significantly more patients receiving SIM01 than controls developed SARS-CoV-2 IgG antibody (88% vs 63.3%; P = 0.037) by Day 16. One (4%) and 8 patients (26.7%) in the SIM01 and control group, respectively, failed to develop positive IgG antibody upon discharge. At week 5, plasma levels of interleukin (IL)-6, monocyte chemoattractant protein-1 (MCP-1), macrophage colony-stimulating factor (M-CSF), tumor necrosis factor (TNF-α), and IL-1RA reduced significantly in the SIM01 but not in the control group. There was a significant negative correlation of nasopharyngeal SARS-CoV-2 viral load and SIM01 intervention. Metagenomic analysis showed that bacterial species in SIM01 formula were found in greater abundance leading to enrichment of commensal bacteria and suppression of opportunistic pathogens in COVID-19 patients by week 4 and week 5. Conclusions: This proof-of-concept study suggested that the use of a novel gut microbiota-derived synbiotic formula, SIM01, hastened antibody formation against SARS-CoV-2, reduced nasopharyngeal viral load, reduced pro-inflammatory immune markers, and restored gut dysbiosis in hospitalised COVID-19 patients. TW110115155). Prof. Siew Ng and Prof. Francis Chan are inventors of patent applications for "Therapeutic and Diagnostic Use of Microorganisms for COVID-19" (US63/016,759, US63/015,310, US63/064,821, PCT/CN2021/090488, and TW110115153). No other potential conflict of interest relevant to this article was reported. No other potential conflict of interest relevant to this article was reported. Financial support: This study was supported by a generous donation from The DH Chen Foundation. Clinical Trial Registry: The trial..
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Late treatment
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